Comparative study of various grading systems in oral squamous cell carcinoma and their value in predicting lymph node metastasis

Background: Regional lymph node (LN) metastasis is the single most prognostic factor for oral squamous cell carcinoma (OSCC). An analysis of the prognostic factors is important for predicting prognosis and reducing the mortality in these patients. Objectives: (1) To compare the value of various grading systems in predicting LN metastasis. (2) To evaluate histopathological parameters, which could help in predicting LN metastasis. Materials and Methods: A total of 20 excisional biopsies of OSCCs, were graded according to the four grading systems that is, Broder's, Jakobsson's, Anneroth and Hansen's, and Brynes. We also evaluated various histopathological parameters, which could help in predicting LN metastasis. Results: Grading at the invasive front was most prognostic of LN metastasis. Tumors with total malignancy score ≥8 showed higher incidence of metastases. Conclusion: The histopathological parameters that could help in predicting lymph node metastases (LNM) are keratinization, nuclear pleomorphism (NP), and the pattern of invasion (POI) when assessed at the invasive front. When the whole tumor was considered, histopathological parameters like NP and POI were significant in predicting LNM.